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Infection in Oral & Maxillofacial Region
Pandect Yu Chuang-Qi
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Infection--- in oral & maxillofacial region
Pandect Infection--- in oral & maxillofacial region Infection Conception Trait Anatomy Arising Route Mutation Influence factors Diagnosis Principles Treatment Principles
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Infection---conception
Infectious agent(bacteria) Host Inflammatory reaction protective and defensive Beneficial Elimination the infectious pathogen Repair tissue injury Harmful Hypersensitivity Autoimmune disease
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Trait of anatomy Oral and nasal cavity Tooth Space
Blood and Lymphoid system Bacteria
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Trait of anatomy Bacteria---Exist Oral and nasal cavity
Maxillary sinus(上颌窦) Temperature + Moisture (Beneficial) Reproduction + Developing
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Trait of anatomy Tooth Caries Alveolar bone Pulpitis Soft tissue
Apical infection Alveolar bone Soft tissue Fascial space
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Trait of anatomy Fascial space(间隙)---loose connective tissue
Among skin, maxillary and muscle Purulent--- spreading way Do not exist in healthy state Become filling during infection
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Cavernous sinus thrombosis
Trait of anatomy Blood and lymphoid system Beneficial Abundance Harmful Encephalic infection Dangerous triangle Lacking valves Cavernous sinus Cavernous sinus thrombosis
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Trait of pathogenic bacterium
Flora(菌丛) Varied Numerous Streptococcus hemolyticus (溶血性链球菌) Staphylococcus aureus (金黄色葡萄球菌) Escherichia coli (大肠杆菌) Anaerobe (厌氧菌) Sterile Simple Complex
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Route of infection Odontogenic infection Adenogenous(腺源性) infection
Traumatic infection Hematogenous(血源性) infection Iatrogenic(医源性) infection
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Odontogenic infection
Periapical infection Pericoronitis(冠周炎)
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Periapical infection Acute-chronic Periapical infection Fistular(瘘)
Cellulitis (蜂窝织炎) Intraoral soft tissue abscess (脓肿) Osteomyelitis (骨髓炎) Septicemia(败血症) Deep fascial space infection Ascending facial-cerebral infection
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Pathways of Periapical infection
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Pericoronitis (冠周炎) Lower third molar
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Infection---Arising Host--- defense system
Microbe---virulence quantity Local circumstance Balance Imbalance Scale
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Mutation Influence factors Changing directions
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Influence factors Host--- defense system Microbe---virulence quantity
Treatment strategy
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Changing directions Localization and recovery Acute chronic Diffusion
Blood system---Septicemia lymphoid system---Lymphadenopathy From submandible space infection to chest region
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How to diagnose? Local Signs and Symptoms
Systemical Signs and Symptoms
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Local Signs and Symptoms
Locally Pain Swelling Surface erythema Pus formation Limitation of motion
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Systemical Signs and Symptoms
Fever Lymphadenopathy Malaise Toxic appearance Elevated white blood cell count
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How to treat? Acute stage Chronic stage
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Acute stage Host Antibiotic therapy Surgical drainage and incision
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Host Defense Mechanisms Critical Principles
Migration of white blood cell Production of antibodies Critical Principles Most important factor --- final outcome The infections--- cured by the host, not by antibiotics
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Principles for choosing appropriate antibiotic
Antibiotic era causative organism(致病菌) sensitivity specific, narrow-spectrum antibiotic least toxic antibiotic drug history(success, allergic and toxic)
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Principles of antibiotic administration
Proper dose Proper time interval Proper route of administration(oral, parenteral) Combination antibiotic therapy
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Surgical drainage and incision
How to judge the pus formation? Purposes of surgical drainage and incision Principles of surgical drainage and incision
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How to judge the pus formation?
Characteristic Duration--- >5 days Palpation---Fluctuant Appearance---Reddened Needle aspiration B-ultrasound CT Three stages Inoculation Cellulitis Abscess
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Fluctuant examination
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Purposes of surgical drainage & incision
Rid the body of toxic purulent material Decompress the tissues Allowing better perfusion of blood containing antibiotics and defensive elements Increased oxygenation of the infected area
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Infection in masseteric space
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Infection in multi-space
Ludwig’s angina
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Principles of surgical drainage & incision
Place the incision in an esthetically acceptable Place the incision in a dependent position to encourage drainage by gravity Dissect bluntly through deeper tissues and explore all portions of the abscess Place a drain and stabilize it with sutures
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Principles of surgical drainage & incision
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Chronic stage Surgical removal of the focus(病灶)
Lesion tooth---Impacted tooth Osteomyelitis
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Infection in oral & maxillo-facial region
Conclusion Infection in oral & maxillo-facial region The trait of Infection Odontogenic infection mutation of infectious Diagnosis of the infection Diagnosis of the abscess formation The principles of the treatment
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Thank you
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